Become a Technician

osaki technician form

Please fill out the form below if you’re interested in partnering with us as a technician.
Copy of Insurance is to be submitted.
If you have questions, please call us at 888-848-2630.
[ *:required fields ]

Contact / Company Name*:
Company Tel*:
Company Address *:
Company City*:
Company ST*:
Company Zip*:
Company Email*:
Years in Business:
Are you an accredited business with BBB?:
EIN#*:
State Resale Certificate#*:
Work Area Radius (miles):
Are you Insured?*: Please attach a copy of insurance. (jpg format size less than 2M)
Do you have any criminal record?:
Please note if you agree to render warranty services for titan chair, all work orders must be completed within 4 business days of receiving the work order. *